So many women hear the phrase, “your labs are normal"—even when they don’t feel anything close to it. The truth is, typical ranges aren’t always designed with women’s unique physiology, or life stage, in mind. That’s why Dr. Christy Evans, OB/GYN at Almond and functional women’s health practitioner, takes an integrative, root-cause approach to lab testing. Here, she breaks down exactly which markers are worth tracking, the tests that reveal more than symptoms alone, and how labs can guide care in perimenopause, PCOS, postpartum, and beyond. We recommend saving this article and sharing with your provider when you're seeking deeper hormonal guidance.
Read more to understand how to connect results to symptoms, and why your body’s signals are a roadmap—and ultimately, how it's not all in your head.
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Q: When results are called "normal," how do you decode what’s really going on?
When I hear that a patient has been told her labs are 'normal,' yet she still doesn’t feel well, I always start by redefining what 'normal' means. Conventional reference ranges are often based on population averages—and historically, largely on male data—not on what’s truly optimal for a woman, especially at a specific stage of life. I prefer to use narrower, evidence-based optimal ranges that better reflect women’s physiology."
"The second key point is that labs are only one part of the picture. I don’t look at numbers in isolation; I ask whether they align with how a woman is actually feeling. I connect results with her symptoms, menstrual cycle patterns, lifestyle factors, and health history. This approach allows me to recognize early imbalances and support her before they progress into more significant health issues.
Q: How do advanced labs help move beyond symptom management and into true root-cause care?
One of the guiding principles in my care is that we don’t stop at symptom management—we keep investigating until we understand the “why” behind a woman’s symptoms. I take a stepwise approach: starting with a comprehensive evaluation that includes a detailed history, physical exam, biomarker testing, and an assessment of the core pillars of health. From there, we layer on more advanced labs when needed.
Tests such as a full thyroid profile, menstrual cycle hormone trackers, or stool and microbiome testing help us see how hormones are metabolized, how the gut and liver are functioning, and whether nutrient deficiencies or inflammatory patterns are present. This deeper insight allows us to identify and address the root causes, so we can create lasting solutions rather than simply masking symptoms.
Q: What are the “must-know” markers in labs that give you the clearest snapshot of a woman’s overall health?
I recommend the following markers on at least a yearly basis. These together give a strong overview of hormonal balance, metabolic health, and nutrient status.
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Complete thyroid panel (TSH, free T4, free T3, reverse T3, antibodies)
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Fasting glucose, insulin, HbA1c
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Ferritin, iron studies, B12, folate, vitamin D
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High-sensitivity CRP
Q: What can a full thyroid panel tell us that a basic test might miss?
The thyroid influences everything—energy, cycles, fertility, mood, weight, and even perimenopause transitions. Oftentimes, your provider will start by testing a TSH, which serves as a screen for thyroid dysfunction. However, it might not tell us a full picture, and may miss underlying clues about your thyroid health. For example, if free T3 is low but TSH is “normal,” that could explain fatigue or hair loss. If antibodies are present, it may signal an autoimmune process that’s affecting cycles and fertility. Looking at the thyroid in detail helps me connect seemingly unrelated symptoms and guide more targeted treatment.
Q: For women with irregular cycles or think they may have PCOS, which specific markers do you always check?
I typically order:
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Total and free testosterone, DHEAS, androstenedione
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Fasting insulin and glucose, HbA1c
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17-OH progesterone
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Thyroid panel (since thyroid dysfunction can mimic PCOS)
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hs-CRP
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Complete blood count
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LH, FSH, AMH
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Prolactin
Q: What are the most helpful labs for women experiencing unexplained weight gain, fatigue, or low energy?
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Thyroid panel
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Fasting insulin, HbA1c, glucose
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Cortisol
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Iron studies, ferritin, B12, vitamin D
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Inflammatory markers (hs-CRP, homocysteine)
Q: As women, which nutrients and ingredients are important to supplement for hormonal support?
A good baseline includes: magnesium, vitamin D, omega-3s, and a high-quality multivitamin with methylated B vitamins.
For PCOS: inositol, NAC, and omega-3s can support insulin and hormone balance.
For postpartum: continued prenatal with iron (if needed), choline, DHA, and probiotics are crucial.
For perimenopause: magnesium, vitamin D, omega-3s, and adaptogens (like ashwagandha or rhodiola) can support stress resilience.
I recommend Perelel, since they are stage-specific and formulated with women’s hormonal transitions in mind.
Q: When it comes to perimenopause and menopause, which additional markers help you build a clearer picture of this life stage?
I look at thyroid, fasting insulin/glucose, testosterone, cortisol, hs-CRP, homocysteine, Vitamin D and lipid panels. These help identify why some women experience more brain fog, weight changes, or fatigue. Cortisol, in particular, tells me how stress is interacting with hormones—often the hidden driver of symptoms.
Q: Let's talk chronic UTIs, BV, and yeast infections—how can lab testing of the vaginal microbiome or immune markers guide care?
Advanced vaginal microbiome testing can show if protective Lactobacillus species are low, if there’s overgrowth of disruptive bacteria or yeast, or if the vaginal pH is off. This helps us move from a cycle of endless antibiotics or antifungals toward restoring balance and resilience.
Q: When it comes to getting sick often, are there certain markers to check our immunity?
Yes—low vitamin D, zinc, selenium, or iron can weaken immune defenses and increase susceptibility to recurrent infections. Identifying and correcting these deficiencies can be just as important as treating the infection itself.
Q: How can lab testing support hormonal rebalancing in postpartum?
Postpartum is a time of massive hormonal shifts. Checking thyroid, iron studies, vitamin D, and B vitamins is crucial for fatigue and mood. If breastfeeding, we also look at nutrient status to support milk supply. Labs guide us in supporting recovery, energy, and mental health—rather than writing off symptoms as “just new motherhood.
Q: Last question—do you have final thoughts for women who feel like they are dealing with chronic hormonal issues?
I want women to know: your body is never working against you. It may feel that way when you’re exhausted, bloated, or struggling with heavy cycles, but those symptoms are not signs of weakness or failure. They are your body’s language—its way of telling you that something needs attention. Instead of suppressing or ignoring those signals, we can lean in and listen. When we dig deeper with the right questions and an understanding of where you are in your life stage, those symptoms often point us directly toward the imbalance—whether it’s in hormones, thyroid, gut health, or nutrient status. Your body is wise. It is designed for resilience and balance.
Dr. Christy Evans is a board certified OBGYN, functional women's health practitioner, and certified menopause practitioner. She believes it is a privilege to care for women throughout their reproductive journeys and seeks to empower her patients to live their healthiest lives through a personalized, holistic approach. Finally, she is a mother to two very energetic boys.
This article is for informational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and we recommend that you always consult with your healthcare provider. To the extent that this article features the advice of physicians or medical practitioners, the views expressed are the views of the cited expert and do not necessarily represent the views of Perelel.
